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General NPI Number Information
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NPI Number | 1871894675
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Entity Type | Individual
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Provider Name | FATEN Y BAZZI MS, LLP
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Gender | Female
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 363 W BIG BEAVER RD STE 315
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City | TROY
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State | MI
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Zip | 48084-5242
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Country | US
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Telephone | 248-354-8460
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 EASTHAM RD
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City | DEARBORN
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State | MI
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Zip | 48120-1049
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Country | US
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Telephone | 313-505-0594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014548
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6361007094
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License Number State | MI
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